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There is one common goal in the diabetes healthcare industry: we want to make life with type 1 diabetes (T1D) better. The true aim isn’t just about “better” blood sugar levels but about a person’s overall quality of life. Innovation in technology and treatments is critical to improving the daily experience of living with this disease.
This year’s DiabetesMine Innovation Days event in San Francisco, CA brings nearly 100 diabetes leaders, entrepreneurs, product developers, and people with diabetes (PWDs) together to discuss T1D innovation and data.
Here’s a glance at the work presented at this event through the eyes of Ann Mungmode, MPH, CPHQ, Quality Improvement Program Manager at T1D Exchange.
Emerging diabetes products
Daniel Kraft, MD argued that healthcare is well behind the rest of society — it hasn’t changed systemically in decades despite evolution everywhere else. (Oh, except — he argued that electronic medical record management is perhaps one step forward.)
“He invited attendees beyond reactive and proactive ‘sick care’,” explained Mungmode, “but to support prevention and predictive healthcare by tapping into the wealth of data, supporting patients, and creatively leveraging lessons from other fields.”
Fortunately — outside of the healthcare space — innovative minds are developing new products and technology every year.
The variety of innovative products presented included:
- Episodic nighttime automated insulin delivery (AID) for smartpen users
- Temperature-controlling insulin boxes
- Ability to bolus directly from your smartphone with the t:slim X2 insulin pump
- BluHale device and app for Afrezza inhaled insulin to track dosing
- The Tempo device and app for insulin pens to track insulin dosing
- OneDrop’s continuous glucose monitor (CGM) 24-hour patch
- …and more!
Every presenter expressed a similar message: Diabetes-related products should not add to the burden of an already relentless chronic condition.
“Sounds straightforward enough,” reflected Mungmode, “until you consider that everyone’s experience living with diabetes is different, and considering those differences and unique challenges, would be transformative for the millions of people living with diabetes around the globe.”
The healthcare system still shames patients who struggle
“Don’t get me wrong; innovating diabetes products would significantly impact PWD,” expressed Mungmode. “But innovations are decidedly not limited to technology and product development.”
The focus comes down again to this critical question: how can we improve this archaic healthcare system?
People with T1D inevitably interact with dozens of providers and systems in their effort to stay alive, but presenters reminded everyone at this event that we’re still structuring healthcare on a “compliant vs. non-compliant” system.
Instead of viewing a patient as struggling — and in need of additional support — they are inevitably shamed and left feeling an overwhelming sense of failure.
In doing so, we can consider, for example, how colonialism and slavery have manipulated food culture in such a way that dehumanizes foods eaten by people of color in the U.S.” explained Mungmode.
“Speakers and patients referenced how a sense of ‘surveilling’ or ‘grading’ patients on their food choices reinforces stigma, and that if the foods you, your family, and culture eat every day are not deliberately included in healthcare conversations, it reinforces feelings of ‘not belonging.’”
This highlights the critical issue emphasized by Osagie Ebekozien, MD, MPH: that implicit bias (largely related to race and ethnicity) within the healthcare system is still a significant and critical obstacle to improving care and quality of life for people with diabetes.
“However, implicit bias can be identified so when it does make an appearance (for example, when a provider assesses whether a patient should be recommended a new diabetes technology), the effects of that bias are mitigated by the sound, thoughtful systems surrounding that provider,” explained Mungmode.
Marisa E. Hilliard, Ph.D. encouraged a reframing of the mental health burden of diabetes to focus on resilience and a patient’s strengths. She emphasized the responsibility of leaders in healthcare, policy and advocacy, and public health to support institution- and systems-level innovations that truly address these unavoidable obstacles.
So much work left to be done
Despite incredible progress in technology, treatments, and products for people with T1D, very little has been done to address the burdens of systemic racism or extreme poverty — and its inevitable impact on a person’s ability to manage a chronic disease.
“Many entrepreneurs described how they initiated their company on a small scale, with the population conveniently accessible through neighboring geography,” explained Mungmode. “Starting small is, after all, a similar concept in QI. Still, it doesn’t lead to systems-level impact until it meets two additional criteria: first, it incorporates diverse PWD’s voices and experiences, and second, scales up to become the status quo. The goal is that the small test becomes the standard of care for all within that hospital system.”
Mungmode also expressed frustration at the often 17-year gap between published research results and the actual implementation of those results into patient care.
“Addressing this intensely long implementation delay is one of my favorite components of working with the T1D Exchange Quality Improvement Collaborative (T1DX-QI),” explained Mungmode, highlighting the difference in traditional research versus quality improvement research — the latter can lead to changes in patient care quickly.
“I encourage innovators to influence cross-sector collaborations to engage diverse patients, learn quickly and effectively in various settings, and leverage relationships to diffuse innovations quickly.”
“After attending the DiabetesMine Innovation Summit,” added Mungmode, “I am enthusiastically looking forward to the innovations led by the T1DX-QI and other innovators in the next year, and ten years. After all, the opportunities are endless.”
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